levels of DNA fragmentation who have varicoceles benefit from surgical repair of the condition because it lowers the amount of damage to normal and thereby allows for increased chances of conception. It has also shown that the source of the sperm does influence outcomes of IVF. Sperm retrieved from the testicles seems to have lower levels of damage than poor quality ejaculated sperm in men with sperm storage and transport problems. In these cases, sperm are damaged in the reproductive tract after they leave the testicle. Sperm inside the testicle seem to be protected because of the high level of antioxidants within the testicle. In couples who have failed multiple cycles of IVF, using testicular sperm during a subsequent IVF cycle has lead to over 60% pregnancy rate in several studies and provides a new option to help improve outcomes in these selected patients.

This research has also provided the rationale for treating male infertility with high levels of antioxidants and supplements. If free radical peroxidation leads to sperm DNA fragmentation and if antioxidants can neutralize or reduce oxidative stress in the semen, then it would make sense that supplements containing a combination of vitamins, minerals, bioflavinoids and antioxidants can improve sperm quality to some extent. Research is currently ongoing in this area.

Another condition where new techniques have helped improve outcomes is non-obstructive azoospermia (no sperm in the ejaculate because of a production problem). Over the last decade, it has become evident that sperm production in the abnormal testicle is not

uniform, it can be limited to small pockets in some situations. Rondom testicular biopsies may miss a pocket of sperm production and fail to retrieve sperm in a percentage of men who may actually have small amount of sperm production. A microsurgical approach allows these pockets to be visually detected and increases the sperm retrieval rate to up to 75% of patients. The technique is called testicular microdissection or MicroTESE and this can be the difference between failure and the ability to father a biological child. Men who have had prior negative random biopsies may have sperm retrieved via this approach.

CONCLUSION New testing methods and treatments for male

infertility continue to evolve and improve our ability to help men become fathers such that very few men can not become a biological parent.

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